Carnival Cruise Lines has been in the news lately with four of its cruise ships failing sanitation inspections in the last two months and a total of five ships failing USPH inspections in the last year.

The Carnival Vista (79), Carnival Breeze (77), Carnival Triumph (78), and the Carnival Liberty (80) all recently failed USPH inspections, The Carnival Paradise (83) also failed the VSP inspection last year. Last year also saw the Carnival Conquest (89), Carnival Dream (87), Carnival Fantasy (88) and Carnival Imagination (89) receiving very low sanitation scores. This year, the Carnival Vista received a low score of only 88 during its re-inspection (although the CDC has still not officially posted the score on its data base yet), following its disastrous score of 79 in December 2017 where USPH inspectors caught Carnival hiding food and galley equipment in crew member cabins.

You can see all of the most recently published USPH sanitation scores in the CDC's Vessel Sanitation Programs' (VSP) "Green Sheet" (warning the CDC often delays the publishing of sanitation scores online).

But Carnival is not the only cruise line suffering from failing or low sanitation scores.

In the last month, two Royal Caribbean cruise ships have received scores barely above the failing score of 85. The Grandeur of the Seas received a score of 87 in an inspection which took place on January 5, 2018 which was only recently published. There were deductions for various unsanitary conditions as well as heavily corroded and difficult-to-clean steel counters in the galleys of the ship which you can read here.

Some people may point out that the Grandeur (photo right) is an older ship in the Royal Caribbean fleet, having come into service well over 20 years ago and showing obvious signs of external rust and lack of maintenance. But the Allure is obviously a newer and arguably better maintained ship.

But the recent USPH report involving the Allure of the Seas shows that it received a barely-passing score of only 86. The acute gastroenteritis (AGE) logs indicated that a Royal Caribbean food handler who was symptomatic with acute gastroenteritis symptoms returned to work before the completion of the mandatory 48 hour isolation period. A second crew member exhibited acute gastroenteritis symptoms continued to eat meals in the crew mess and did not report to the ship infirmary until over two days later. Another crew member who was symptomatic with AGE symptoms proceeded to eat in crew mess and attend a work meeting, and reported to the ship's medical department only later.

Even more disturbing is that the USPH inspectors found the following:

"Seat cushions had storage under them in the Windjammer and decks 3, 4, and 5 of the main dining room. These storage areas were heavily soiled with debris, had raw wood, and were located above carpet and/or concrete decks. In these areas, the inspection team found: two closed gallon bottles of drinking water, several bags of neatly folded and bagged linen napkins, a bucket full of silverware, a box of gloves and wiping cloths, wrapped salad stands, several bottles of kitchen degreaser, chlorine bleach, biogel, wet plastic containers, and a large bag with dozens of serving utensils. These were also found along with brooms, dust pans, vacuum cleaners, and other nonfood equipment."

This sounds like a crew member or crew members tried to hide cleaning materials along with napkins, eating and serving utensils in obviously improper locations which were described as heavily soiled area in the Windjammer Cafe and main dining room. It is difficult to believe that the USPH did not fail the ship for this intentional type of unsanitary conduct. The purpose of USPH cruise ship inspections is to prevent the spread of shipboard disease outbreaks.

Perhaps coincidentally (or not), in December of 2017, Royal Caribbean notified its oncoming passengers that "some guests onboard experienced gastrointestinal illness. In an abundance of caution, we are conducting enhanced sanitizing onboard the ship and within the cruise terminal to help prevent any illness from affecting your cruise."

The questions arises why so many cruise ships operated by both Carnival and Royal Caribbean are receiving low and sometimes failing sanitation scores. Crew members hiding food or eating utensils and working while ill are hardly new. Are USPH inspectors more vigorously inspecting the ships? Or this the result of too much work and too few crew members who are responsible for cleaning the ship, as some people say?

After miserably failing the December 2, 2017 sanitation inspection by the United States Public Health (USPH) last month, the USPH re-inspected the Carnival Vista today at the port of Miami. The Carnival cruise ship passed the re-inspection with a score of only 88, three points above the failing score of 85.

The December 2nd sanitation inspection found that Carnival Vista crew members were caught hiding perishable food and galley equipment in crew quarters. The report stated that "an organized effort was made to physically move several containers and trolleys of food equipment, utensils, spices, potentially hazardous food items, raw produce, and decorations to a crew cabin hallway and a crew cabin in order to avoid inspection by VSP staff."

Last month, the USPH sanitation inspection resulted in a failing score of only 79.

The USPH concluded that crew members moved trolleys filled with lexan boxes of perishable food and galley equipment in order to hide the items from the inspectors. Included on the trolleys were lexan boxes filled with butter, buttermilk, whipping cream, raw salmon, raw lamb and other meats. Inspectors discovered a skillet of lasagna near a crew member bed. Mixed with this food in the lexan boxes were galley machine equipment and batteries, among other items. Flies were found in some food containers.

The Centers for Disease Control (CDC) delayed from December 2, 2017 until January 16, 2018 - a period of six weeks - before publishing the failed score and disclosing the intentional misconduct by Carnival to the public.

The re-inspection score of only 88 is one of the lowest scores, without failing, of a ship operated by a major cruise line in the past year. Unfortunately, the CDC does not have the leadership to punish Carnival for its deliberate wrongdoing, such as ordering the Vista cruise ship not to sail.

The re-inspection today found more unsanitary conditions, to be officially disclosed by the CDC to the public at some time in the future.

The Vista is one of four Carnival cruise ships to have failed the inspection by the Vessel Sanitation Program (VSP) in the last four months, including the Carnival Breeze (77), Carnival Triumph (78), and the Carnival Liberty (80). The Carnival Paradise (83) also failed the VSP inspection last year.

A crew member who wishes to remain anonymous sent us the draft report today.

The purpose of the Vessel Sanitation Program (VSP) at the Centers for Disease Control and Prevention (CDC) is to assist the cruise ship industry to "prevent and control the introduction, transmission, and spread of gastrointestinal (GI) illnesses on cruise ships." VSP operates under the authority of the U.S. Public Health Service Act.

USPH sanitation inspectors conduct inspections twice a year on cruise ships when they are in a U.S. port. The inspections are supposedly a surprise, although many crew members have stated that federal inspectors sometimes give advance notice of the inspections to the cruise ships. A score of 85 or below constitutes a failed sanitation score, and often leads to the firing of the shipboard Food & Beverage department heads and/or managers and always result in increased work by the shipboard employees.

Market Watch just published a comprehensive article, by reporter Jacob Passy, titled Record Number of Cruise Ships Failed Health and Safety Inspections in 2017, concluding that there were 14 instances where a cruise ship failed a sanitation inspection last year. The article found that Carnival Cruise Line cruise ships received five failing grades, in addition to one one failure this year.

Carnival claims that its food handling and preparation are of the "highest quality, which seems questionable regarding the details of the scores like on the Carnival Breeze (77), Carnival Triumph (78), Carnival Vista (79), Carnival Legend (83), and Carnival Paradise (83). The Carnival Liberty failed this year with a score of only 83.

The Carnival Vista was re-inspected yesterday and receive a score of only 88, a passing but not a good score coming off of such a spectacular failure last year. The CDC has not published the re-inspection score yet.

Carnival also claims that it "immediately" corrected the unsanitary conditions found by the inspectors. (Carnival ships failed inspections 4 times in the last 2 months). But the truth is that Carnival has still not even filed a "corrective actions" report for the Carnival Vista which failed the USPH inspection last year. The report found that not only did Carnival try to intentionally hide food and dirty galley equipment in crew quarters, but the the USPH noted that a Carnival supervisor disciplined a food handler who was experiencing acute gastrointestinal virus symptoms when he did not report to work.

The VSP requires cruise lines to correct the non-conforming conditions and file a "corrective report" promptly after the violation. The Vista failed its inspection over six weeks ago, but Carnival has still not filed a corrective report as of today's date, January 27, 2018.

Market Watch state that the CDC can advise a ship not to sail if "particularly egregious violations are uncovered," which may be true in theory but never occurs in reality. It's difficult to imagine more egregious violations than what the USPH found on the Vista last month, but there is no evidence that the cruise line has even bothered to file a report admitting to its violations and outlining its corrective actions.

Part of this problem is that there is often a cozy relationship between federal inspectors and cruise line officials where unsanitary conditions are sometimes not noted or enforced. Indeed, it took over a month for the CDC to even publish the failed inspections on the Carnival Breeze and Carnival Triumph last month on its official website.

A shore-side restaurant with a failed health inspection will quickly find a "closed due to health inspection" placard (photo right) taped on its front door. For health violations on cruise ships, however, the public has to search the online database, which is often not current, for information.

A cruise ship which is caught intentionally hiding food and galley equipment in its crew quarters, or which does not timely submit a corrective report, should be barred from sailing. A local shore-side restaurant would be shut down in a minute for such unsanitary conditions. But the USPH often bends to the cruise line's the-show-must-go-on mentality.

Market Watch interviewed cruise expert cruise expert Dr. Ross Klein who noted that a failed CDC inspection is all the more questionable when looking at the details of the reports for cruise ships that have actually passed inspections. According to Dr. Klein, “you can get 100% but there can still be a number of citations for things that were not up to standards."

Market Watch wrote that one ship which received a 100% score was cited for storing boxes of fruit juice near raw egg shells and for one crew member was working while showing symptoms of gastroenteritis.

Dr. Klein also noted that the Vessel Sanitation Program applies only to cruise ships calling on U.S. ports. Few countries outside of the U.S. inspect cruise ships for sanitation problems.

Which cruise ships which flunked the USPH sanitation inspections last year? See the list below:

I first learned that the Liberty failed the sanitation inspection by the United States Public Health (USPH) on January 6, 2018 when a crew member notified me of the failure of the inspection which took place on two days earlier, on January 4th.

This is the fourth failed USPH inspection in under two months, following the failed inspections of the Carnival Breeze (77 score), Carnival Triumph (78 score) and the spectacular failure of the Carnival Vista (79 score) where crew members were caught hiding food and galley equipment in crew members quarters from USPH inspectors.

The official report of the failed inspection of the Liberty (with a score of only 80), which can be retrieved here, reveals that the Liberty failed the inspection for all of the reasons which a cruise line could possibly fail such an inspection - soiled galley surfaces, dirty equipment, files in the galley's food preparation areas, dirty plates with food residue, broken dish and pot washers, improper food temperature systems, contaminated foods, corroded ovens, lack of sneeze guards, improper (low) temperatures of dishwashers, improper sanitation standards for whirlpools, and a sick crew member who continued to work although he was experiencing acute gastroenteritis (AGE) symptoms.

As we have mentioned before, it is difficult to understand why the CDC fails to timely publish the failed scores of its USPH sanitation inspection of the Carnival ships. It has been three weeks since the Carnival Liberty failed the inspection and the CDC finally published the failed score only today. Carnival has not still bothered to prepare a "corrective action" report as required by the Vessel Sanitation Program (VSP).

The CDC is supposed to protect the public from disease and infections due to unsanitary inspections but it does not timely publish its reports nor demand compliance by Carnival with the VSP requirements.

As I have stated in prior articles regarding the recent rash of guests going over the rails of its cruise ships, Carnival has a reputation as providing affordable "fun ships" for the masses. But, in truth, it is a recalcitrant cruise line that has a history of non-compliance with the few U.S. laws which apply to the foreign-flagged cruise industry. In the last year, it was been fined $40,000,000 for lying to the U.S. Coast Guard regarding the widespread oil pollution from its fleet of cruise ships. More recently, the Carnival Vista was caught engaging in deceitful conduct of trying to hide food and galley equipment from USPH sanitation inspectors. It's the one cruise line which refuses to hire lifeguards, when other lines (Disney, Royal Caribbean and NCL) have finally done so. So perhaps it's no surprise, when it come to the issue of its guests going overboard, that Carnival refuses to implement automatic man overboard technology ever since the 2010 Cruise Vessel Security and Safety Act (CVSSA) went into effect.

Does the U.S. federal government have to assign permanent sanitation inspectors to prevent the ship managers from ordering crew members from trying to hide food and unsanitary equipment from the USPH? After the Carnival Vista was caught trying to play hide and seek from USPH employees, the question was how many other Carnival ships routinely engaged in this sneaky practice? Should VSP representatives treat Carnival like the U.S, Department of Justice (DOJ) has done by placing it on probation for years with routine audits of its ships?

Yesterday, the Carnival Glory received a score of 99 by the United States Public Health sanitation inspectors at the port of Miami. The Centers for Disease Control (CDC) has not officially published the score on its Vessel Sanitation Program (VSP) database yet. A draft report, sent from a crew member who wishes to remain anonymous, is below.

The passing score is good news for Carnival which has recently seen three of its cruise ships receive failing scores from USPH sanitation inspectors (the Carnival Triumph, Carnival Breeze and Carnival Vista). The USPH caught Carnival intentionally trying to conceal food and galley equipment from sanitation inspectors by placing the food and galley items in crew member cabins and hallways during an inspection of the Vista in December.

A number of newspapers, including the Miami Herald, covered the stories of the failed Carnival sanitation and health scores. This was particularly embarrassing for Carnival as the Triumph, which infamously earned the nickname as the "poop cruise" for unsanitary conditions following an engine room fire which disabled the ship several years ago, received a score of only 77 out of 100.

There was a considerable delay by the CDC in posting the failed scores of the Carnival cruise ships on its VSP database. In the case of the Vista, the CDC did not post the failed sanitation score until over six weeks after the failed sanitation inspection. Carnival claimed that it immediately addressed the problems, but it had still not filed a corrected actions report, indicating that the cruise ship corrected the sanitation deficiencies, when the report was finally posted the following month.

The cruise industry's trade organization, the Cruise Line International Association (CLIA), and several travel publications which cater to the cruise lines, have recently tried to counter the bad publicity caused by the three failed scores for the Carnival ships, by issuing press statements or articles pointing out that 33 cruise ships earned perfect 100 scores in the past year.

The last USPH inspection of the Glory occurred last April and resulted in a score of 97.

Today, the Miami Herald covered the delayed story of the Carnival Triumph flunking a November 2017 USPH inspection when it received a score of only 78.

The reason why I called the story "delayed" is because Carnival crew members on the Carnival Triumph talked about the failed USPH score about six weeks before the Centers for Disease Control and Prevention (CDC) published its official report. The news first broke about the Triumph flunking the inspection when the crew members tipped off the popular Crew Center web site which first reported the story in mid-November of 2017.

We have also received tips of failed USPH inspections, such as when the Carnival Breeze failed a USPH inspection (receiving a 77) and when the crew members aboard the Silver Shadow his food and galley equipment in crew quarters.

The Herald characterizes the failed USPH score as "rare," but that seems entirely debatable. The article quotes cruise fanatic Stewart Chiron saying that “as far as a large ship, I couldn’t tell you the last time this happened. That’s how rare this is.”

But the cruise fans forgot about over ten USPH failed inspections in the last few years, starting with the Carnival Breeze just last month (which Carnival has not even acknowledged to date). Then there was also the Carnival Paradise scored just a 83 in June 2017, which the article briefly mentioned.

20 cruise ships flunked surprise USPH sanitation inspections in five years. That does not seem particularly "rare" to me.

Also, remember that that Carnival crew members stated that the Triumph failed the USPH inspection about six weeks before the agency finally produced the official report. The same thing happened with the Carnival Breeze where crew members have talked about the failed inspection last month to the crew-center website but the CDC has not even published its report yet.

It seems disconcerting, to me at least, that if the Centers for Disease Control and Prevention is really concerned about controlling and preventing disease on cruise ships, that it would sit on reports of potential public health hazards on several cruise ships for over a month.

January 5, 2018 Update: A reader left a comment below that the Regent's Seven Seas Navigator received a failing score of 79 (2013) raising the total number of cruise lines which flunked USPH inspection to 21 in the last five years.

The Centers for Disease Control and Prevention (CDC) finally published the report of its sanitation inspection for the Carnival Triumph. As you can read in the official report posted on the CDC website, the Carnival cruise ship received a failing score of 78. During its November 11, 2017 inspection, USPH inspectors numerous "heavily soiled" food preparation and storage surfaces among other shortcomings in the ship's food service areas.

A score of 85 or lower is considered a failure.

Over six weeks ago, the popular Crew Center reported that the "Carnival Triumph failed to pass the recent USPH Inspection. Centers for Disease Control and Prevention Inspectors boarded the vessel on November 11, at the port of New Orleans, Louisiana, and found multiple violations. (The) CDC has not yet released an official report on their website, however, several crew members have reported that the final USPH score was 78."

The Triumph has still not filed a corrective actions report with the CDC.

Earlier this month, we received a similar tip from Carnival crew members after on the Carnival Breeze, failed a USPH inspection in Galveston. According to these crew members, the USPH gave the ship a failing score of only 77. However, as was the case with the Triumph, the CDC did not disclose that the Breeze received a failed score nor did it publish the inspection report.

We have received similar tips over the years from cruise ship employees, including from crew members on the Silver Shadow where crew members were instructed to hide food, dirty pots & pans and cooking equipment from U.S. health inspectors. The Silversea cruise ship eventually received a failing score of 82. CNN aired a special on the story.

According to crew members on the Carnival Breeze, the Carnival cruise ship was in Galveston Sunday when the United States Public Health (USPH) came aboard the ship for a semi-annual sanitation inspection. According to these crew members, the USPH gave a failing score of only 77, although the Centers for Disease Control and Prevention (CDC) has not published its official report yet.

A score of 85 or lower is a failing grade, according to the CDC.

The low score is highly unusual for this ship, which received scores of 97, 100, 98, 100 and 97 on the last five USPH inspections over the last several years. The Breeze has not received a score less than 90 since it came in service in 2012.

But the low score of a Carnival ship is not unprecedented. A month ago, the popular Crew Center reported that the "Carnival Triumph failed to pass the recent USPH Inspection. Centers for Disease Control and Prevention Inspectors boarded the vessel on November 11, at the port of New Orleans, Louisiana, and found multiple violations. CDC has not yet released an official report on their website, however, several crew members have reported that the final USPH score was 78." The CDC has still not published its report on the alleged failed USPH inspection.

Passengers aboard a Holland America Line (HAL) cruise ship have fallen ill with symptoms consistent with norovirus on an approximately two week trans-Atlantic cruise that departed from Civitevecchia, Italy on November 3rd and arrived today in Tampa, Florida.

According to the Centers for Disease Control and Prevention (CDC), the November 3 - 18 cruise aboard the Oosterdam sickened 86 of 1,843 passengers (4.67%) and 18 of 796 crew members (2.26%) who exhibited symptoms of vomiting and diarrhea.

The link to the CDC about this outbreak is here. There has been no official determination of the cause of the outbreak although norovirus is suspected.

According to the CDC and the FDA, the most common cause of norovirus is contaminated food or water. Of course, like land-based restaurants, ill food handlers often transmit the virus. Passengers can also obviously bring the disease aboard which can spread due to unhygienic conditions caused either by the passengers and/or the cruise line.

Before there can be a scientific determination as to the actual cause of the outbreak, there must first be a serious epidemiology assessment of the ship which the CDC rarely performs due to the quick turn-around of the cruise ship. Unfortunately, in this case HAL immediately argued that norovirus is allegedly "circulating throughout North America and can be easily transmitted if personal hygiene is not maintained," according to a statement that it released to the Tampa Bay Times.

The CDC says that there have been 13 GI outbreaks this year, mostly involving norovirus with two e-coli outbreaks.

The cruise ship says that it performed enhanced cleaning and left today for the Caribbean.

According to the Centers for Disease Control and Prevention (CDC), Royal Caribbean's Empress of the Seas flunked a surprise sanitation inspection conducted in early June. The Empress of the Seas scored a failing score of only 80. You can read the report here. A score of 85 or lower is considered a failure.

The Empress of the Seas underwent an extended period of renovations in Spain and later in Freeport, Bahamas when the ship was transferred back from Pullmantur. Royal Caribbean canceled a total of thirteen cruises scheduled for earlier this year. The first sanitation violation related to the renovation and involved a bathroom for the medical staff which could be used only for storage and was "heavily soiled." Back in April of this year, Royal Caribbean told the Miami Herald that “as work has progressed, we learned that more significant infrastructure and physical improvements across the ship’s multiple galleys and provisioning areas were needed to meet our high standards.”

I was contacted previously by crew members, during the renovation period, who complained of unsanitary conditions on the ship. There was talk that the CDC had inspected the ship and initially had not given the ship a passing score, although there was nothing officially posted on the CDC website. Several crew members said that the ship had fallen substantially in disrepair while operated by Pullmantur and had a major problem with pests.

It is apparent, however, that once back in the Royal Caribbean fleet, the Empress failed to meet high standards. The report regarding the June inspection details forty four CDC violations, ranging from improper procedures to monitor acute gastrointestinal illness cases to incorrect potable water and swimming pool/whirlpool testing.

The report included numerous references to live and dead flies and cockroaches around refrigerators, buffet lines and other areas used for food storage. The ships was also in violation of the CDC's requirement to use rat guards, and was utilizing rat guards on only one out of six mooring lines while the ship was in port.

A crew member states that the Empress was reinspected earlier this month, on July 10th, and received a score of 97. If such an inspection took place, the CDC has not posted that inspection yet.

Two years ago, Market Watch published the 5 Most Hygienic Cruise Lines and concluded that Costa and Disney and three other smaller lines had never failed a CDC inspection. Since then, the Disney Wonder experienced a gastrointestinal outbreak in April of this year.

A gastrointestinal sickness outbreak on the Silver Shadow in March was found by the Centers for Disease Control and Prevention (CDC) to be caused by Enterotoxigenic E. coli (ETEC).

The outbreak occurred during a cruise from March 3 - 21, 2016. The outbreak sickened 37 people according to the CDC report on the incident. The CDC concluded that 24 of 388 (6.19%) passengers and 13 of 366 (3.55%) crew members fell ill due to the disease.

Outbreak News Today said that "according to the Centers for Disease Control and Prevention (CDC), ETEC is a major bacterial cause of diarrhea among travelers and children in the developing world. ETEC is increasingly recognized as an important cause of foodborne illness in developed nations, such as the United States. Infection occurs when a person eats food, or drinks water or ice contaminated with ETEC bacteria. Human or animal wastes (e.g., feces) are the ultimate source of ETEC contamination."

Silversea Cruises was last in the news several years ago when the USPH caught crew members hiding perishable food and galley equipment in crew quarters on the Silver Shadow and flunked the cruise line. CNN covered the scandal. You can see the video here.

The Silver Spirit, on the other hand, has always scored highly by the USPH (93-100) in the last 6 years, and it scored a 98 during the last inspection in January. However, in a lawsuit filed by a Silversea crew member (aboard the Silver Spirit and Silver Wind) in 2011, the crew member alleged that his employment as a bartender was terminated after he complained that he was required to fill expensive, premium top-shelf brand liquor bottles with cheaper brands and to fill empty expensive French champagne bottles with cheaper Italian sparkling wines. The case is Marin Asenov v. Silversea Cruises, Ltd., Case No. 0:11 CV 62360 WJZ. You can read the allegations in the lawsuit here.

Photo credit: This image photographed by Brian Burnell with permission was uploaded to Commons by George Hutchinson. CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=15252523

A month ago, a crew member aboard the P&O Oceana notified me that the cruise ship failed a sanitation inspection by the enters for Disease Control and Prevention (CDC) while the ship was in port in Charleston, South Carolina. Oceana received a score of 82; 85 or lower is considered a failure.

I have been checking the CDC's online inspection scores since then. I have been asking the CDC when it will release its report on the Oceana.

The report was finally released today. You can read the report here. The report indicated that several back-flow prevention devices, to prevent the contamination of potable water, did not have test results and appeared not to be tested. The ship's Riviera swimming pool and Crystal whirlpool did not have adequate levels of chlorinated and bromine, failed to have hair and lint strainers / filters and were not disinfected. The inspector closed the recreational water facilities on the ship.

The report also revealed that a food handler had an onset of Acute Gastroenteritis (AGE) and exhibited symptoms at 9:00 A.M. in the morning but did did not report to the medical center until 11:20 A.M. A review of the crew member's work history indicated that this crew member worked, notwithstanding his illness, from 7:30 A.M. until 10:30 A.M.

The ship's galley appeared dirty. There were comments like "the tile grout in this area was soiled and in disrepair." "The deck below under counter refrigerator . . . had a significant buildup of more than a week's accumulation of food debris, dirt, equipment parts, and what appeared to be insect remains." Food service equipment was broken or out of service and many operational ovens and ice-makers were overflowing their drip pans and/or leaking onto the floor.

In an era when cruise lines are quick to blame every single norovirus outbreak on the passengers, this CDC report provides an insight into how deficient water sanitation and disgusting food handling practices by a cruise line can jeopardize the health of the traveling public.

April 4, 2016 Update: The CDC vessel sanitation inspectors inspected the P&O Oriana in February. Although the cruise ship passed with a score of 90, there were several significant sanitation problems including dirty and out of service galley equipment. Also food handlers working while ill with gastrointeritis: "A Chef de Partie experienced onset of GI symptoms on 20 January 2016 at 6:45 am. This crew member worked from 7 am to 11 am, took lunch at the crew mess, then returned to work from 1 pm to 5 pm. The chef reported his symptoms to the medical center at 6 pm." You can read the report here.

April 5, 2016 Update: Cruise Law News was quoted today in the Southampton's Daily Echo and the U.K.'s Daily Mail.

Fortune magazine also covered the story, writing that it "raises questions about the industry’s squeaky-clean image, and indeed, that there may be more unreported cases that were either ignored or dismissed by the sickened passengers or the cruise lines themselves."

The Centers for Disease Control and Prevention (CDC) flunked Silversea's luxury cruise ship, the Silver Shadow, for unsanitary conditions.

The Silversea cruise ship received a failing score of only 82. The inspectors determined the ship had improper medical protocols for crew members with acute gastroenteritis. The inspectors found 40 unsanitary conditions such as improper temperatures for stored food, improper sneeze guards at the ship's buffet stations, and unsanitary whirlpools.

Incredibly, Silversea refused to submit a corrective action report.

Two years ago, this cruise ship engaged in an intentional, calculated scheme to hide food and galley equipment in crew cabins.Crew members on the ship alerted our firm that they (galley workers) were being ordered by their supervisors to take trolleys of perishable foods (eggs, fish & cheese) to the crew quarters and hide the food from inspectors during bi-annual CDC inspections. We advised the "whistle-blower" crew members to notify the CDC. As a result of a surprise inspection, the CDC discovered that the cruise line hid "over 15 full trolleys" of food and food equipment, pans, dishware and utensils to "over 10 individual cabins" in order to avoid scrutiny of vessel sanitation inspectors. It flunked Silversea with a score of 82.

We found Silversea Cruises to have acted deliberately and unethically. It was obviously not committed to safe food practices, a conclusion which is reinforced by this latest series of violations.

Unfortunately, the CDC can't enter significant sanctions against renegade cruise lines like this even when the cruise ships intentionally violate CDC sanitation protocols. Our government should impose meaningful monetary sanctions and shut cruise ships down when they threaten the health of passengers.

April 13 2015 Update: A passenger contacted me today saying that there was an outbreak the cruise before which sailed from South America and returned to Ft. Lauderdale at the end of March. She said that her husband became ill with noro-like symptoms and the ship had been fumigated during the cruise.

The cruise industry finally instituted Ebola-specific protocols after the highly publicized incident yesterday when a healthcare worker from Dallas was discovered to be on a Carnival cruise to the Caribbean.

Cruise lines like Carnival are finally asking cruise passengers whether they have come into contact with an Ebola patient or worked at a healthcare facility where such a person was treated, within the last 21 days. Cruise lines are also finally inquiring whether the passengers have visited Guinea, Liberia or Sierra Leone within the last three weeks. It was a glaring error not to have such a basic protocol before yesterday.

But there is a problem with the questionnaire. It doesn't address what happens if a passenger checks "yes" to these questions.

Obviously the questions are designed to bar the passenger and his companions from traveling on the cruise ship. The issue remains will the passenger's cruise fare and travel expenses be refunded? Will the cruise passengers receive a full cruise credit?

We know from norovirus cases that many cruise passengers, although they are symptomatic, refuse to disclose that they have a fever and a runny nose. They then get on the cruise ship and infect others.

Many passengers are inherently selfish. They have planned the cruise far in advance. They have obtained vacation time from work and blocked a week of "family time." They have looked forward to the cruise for many months. They have flown or driven long distances to the cruise port at considerable expense. They realize that they will be barred from embarking and their vacation will be ruined if they provide full and complete answers about their health.

Cruise lines are inherently selfish too. Although they collect literally billions and billions each year and pay no U.S. income tax, cruise lines are notoriously stringent in not permitting cruise vacationers to cancel if they experience last minute medical emergencies or even deaths in the family. There is great debate about the need for travel insurance. The attitude toward people who don't purchase insurance and then suffer a medical problem is often "screw 'em."

The result is that cruise passengers are often not honest about their health and the cruise lines are often unreasonable in not permitting their guests to reschedule and issue them a cruise credit.

So they sneak aboard, already infected with the nasty norovirus.

But unlike the noro bug, Ebola is deadly. The consequences of carrying Ebola aboard a cruise ship packed with 5,000 passengers and crew members is too great.

The health questionnaire should include language which states that if you checked "yes" to any of the Ebola questions, don't worry. No you won't be able to cruise, but you are entitled to a full refund and your travel expenses will be refunded as well.

Cruise Critic posted an article today about the new questionnaire. The articles states: "Notably, cruise lines rely on passengers and crew to provide honest and accurate answers in health screenings and on health questionnaires. CLIA said intentionally providing false or misleading answers is a criminal offense and is subject to prosecution."

Threatening cruise passengers with criminal prosecution is ridiculous. It's the wrong idea. First of all, there is no criminal law which applies and no prosecutor will ever take such a case. You can't scare a consumer into doing the right thing.

Instead, the cruise industry has to anticipate that cruise passengers will be less than candid. Cruise lines need to provide an incentive by way of a refund. You can call it the "Ebola refund."

This will require a substantial change in the greedy attitude of the cruise industry. But it's absolutely necessary to prevent what happened yesterday on the Carnival Magic.

The Centers for Disease Control and Prevention (CDC) has documented passengers sailing on Royal Caribbean's Grandeur of the Seas out of Baltimore have been sickened on two consecutive cruises.

The CDC website reflects that 97 passengers and 8 crew members on the Grandeur of the Seas became ill with vomiting and diarrhea. It left April 5 for a seven-day cruise and returns to Baltimore today.

Royal Caribbean Cruises notified passengers who will be boarding today to arrive late at the port because the cruise ship will undergo another round of the so-called "enhanced cleaning."

The Associated Press indicates that Royal Caribbean believes norovirus to be the cause.

As is the situation with virtually all gastrointestinal outbreaks on cruise ships, the CDC has not announced an explanation how the outbreak took place. Contaminated food? Contaminated water? Sick crew members working while ill in the galley or dining rooms? Cruise passengers not washing their hands? (the cruise lines' usual excuse). Your guess is as good as mine.

This is the second consecutive cruise on the Grandeur with a illness outbreak, The CDC reported that 111 passengers and 6 crew members became ill with norovirus on the Grandeur during its cruise from March 28 to April 5. You can read our report here.

The CDC has documented a total of 8 gastrointestinal illness outbreaks on cruises returning to a U.S. ports so far this year. (There was also a norovirus outbreak aboard the P&O Oriana recently). There were just 9 outbreaks in all of last year. Norovirus is cited as one of the reasons the public has less confidence in the safety and reliability of cruising, especially from people who have never cruised before.

This week we were contacted by many cruise passengers asking whether they could cancel the cruise which leaves today because of the ongoing outbreak. Unfortunately the cruise lines hold all of the cards in cases like this. Fear of becoming sick is not a legally recognized reason to cancel a cruise and expect a refund. However, it all depends on the goodwill of the cruise line. A FOX News report indicates that the spokesperson for Royal Caribbean, Cynthia Martinez, said "if passengers don't want to take Saturday's cruise, Royal Caribbean staff will help them reschedule."

Suing a cruise line for compensation when exposed to a gastrointestinal virus is a losing proposition because the CDC does such a poor job trying to determine the cause of the outbreak. In this most recent case the CDC has not determined the type of virus much less how the virus came on the cruise ship.

The last message we received was last night: "I will be traveling on the Grandeur this Saturday as well and our check in time was delayed 4 hours! I will be bringing my own bleach wipes on board. Wish us luck!"

The first official norovirus outbreak on a cruise ship this year involved the Norwegian Cruise Line (NCL) Norwegian Star.

The outbreak occurred during a cruise from January 5-19, 2014. The virus sickened 130 of 2318 cruise passenger (5.61%) and 12 of 1039 crew members (1.15%). You can read the CDC report here.

The CDC concluded that the virus in question which sickened the 142 or so people was norovirus. This was the "causative factor" in CDC parlance. The CDC can usually figure out the "causative factor" and most of the time norovirus is the culprit. But I have never seen a CDC report in the last 10 or 15 years where the CDC figured out how the norovirus came aboard the cruise ship.

The cruise lines always blame the passengers. Sometimes the blame is direct with a cruise line public relations representative pointing the finger at their guests. Sometimes it is more subtle with no blame assessment but in the form of "passengers-need-to-wash-their-hands" type of admonishment.

Determining the cause of a norovirus outbreak is a scientific process to be made by epidemiologists and doctors, not cruise line PR people.

The CDC is severely limited by the few inspectors and epidemiologists who are assigned to the cruise ships. The cruise lines are also eager to re-load their cruise ships and begin another cruise as soon as possible. Our federal government and the cruise lines work together to keep the cruise industry moving. No one wants to inconvenience the next round of passengers and hold a ship in port. Unfortunately, no one is advocating a more comprehensive (and slower) methodical analysis of data.

My suggestion is that any time there is an outbreak, the CDC should automatically conduct a sanitation inspection as soon as the ship returns to port pursuant to its vessel sanitation program (VSP). The inspectors should determine whether the cruise ship's food or water supplies are contaminated. Medical literature indicates that many outbreaks are due to noro-laden food or water. Particular attention should be focused on the crew members' medical records, particularly the logs indicating whether food handlers (cooks and waiters) have reported to the ship infirmary with acute gastrointestinal symptoms of cramping, diarrhea and nausea.

Yes, it will take greater resources from the CDC to accomplish this but it is worth it. The "enhanced cleaning" that takes place after an outbreak is "hit or miss." No one figures out what caused the outbreak. The ship is just pressing everyone to work overtime and spray and wipe everything in sight.

There was no CDC sanitation inspection on January 19th when the Norwegian Star returned to port. I would have liked to see the food handler's medical logs for the preceding two weeks in order to determine whether there were complaints of nausea, diarrhea, cramps, fever and headaches. How did the cruise line handle the illnesses? Did they log all of the complaints and quarantine the sick crew members? Did they interview the crew members' cabin mates to determine whether they were ill too?

The Norwegian Star underwent a CDC sanitation inspection on February 16th. The results were disgusting. Many crew members worked while suffering from acute gastrointestinal illnesses, threatening the health of passengers, and then appeared in the ship infirmary after working. The cruise line failed to properly document and log many of the sicknesses and report them to the CDC. For the January 19th to February 2nd 2014 cruise, the number of sick passengers reached over 2% but the cruise ship did not notify the CDC. Many of the cabin mates of the sick crew members were not interviewed by the ship's medical staff, as required by the CDC protocols.

The following violation was typical:

"Violation: On 28 January, the medical notes indicated a food worker had an illness onset at 0600 with four episodes of diarrhea, abdominal cramps, and a headache, but the AGE surveillance log indicated these symptoms started on 28 January at 1315. On the same day at 1315, this person had their last AGE symptom. There was no documentation indicating how long this person was isolated. This individual had four roommates, but there was no documentation the 48 hour interviews were conducted for three of the four roommates."

The CDC flunked the ship with a score of 82. You can read the CDC report here. In addition to the problems with the sick crew members, parts of the galleys and restaurants were filthy.

Does the CDC employ epidemiologists to study the results of vessel sanitation reports to look for trends to explain why gastrointestinal outbreaks occur? Correlating the medical records of sick food handlers and their cabin mates with outbreaks may be a good idea. A scientific analysis of medical records and logs of crew members with GI problems would certainly be a better use of time than having to listen to the cruise line always blame the passengers for not not washing their hands.

The CDC states that the Veendam cruise ship has returned after a a 14 day cruise from February 8-22, 2014 with 114 of 1273 (8.96%) passengers suffering from norovirus-like symptoms of vomiting and diarrhea. 10 of 575 (1.74%) crew members are reportedly ill.

The CDC has not figured out the type or cause of the disease outbreak.

The CDC has confirmed four disease outbreaks on cruise ships so far this year.

The Centers for Disease Control and Prevention (CDC) has stated that over 600 people have been sickened by the gastrointestinal illness outbreak on the Royal Caribbean Explorer of the Seas, CNN reports.

The Royal Caribbean cruise ship left Cape Liberty, New Jersey on January 21, 2014 for a 10 day cruise through the Caribbean. The ship missed a stop at its private stop in Labadee Haiti after the outbreak. It sailed to San Juan to be cleaned.

The CDC initially stated that over 300 people (281 passengers and 22 crew members) were ill. (Its official report is here with the new statistics). However, over the weekend we began to hear reports from passengers that the number of people suffering from nausea and diarrhea had increased to to over 450 and, now, to over 600.

CNN quotes a spokeswoman with the CDC that more than 600 people on the ship have become ill, reporting vomiting and diarrhea. The CDC spokeswoman said 564 passengers and 47 crew members reported being ill.

Royal Caribbean is ending the cruise two days early. The cruise line will "use the extra time to sanitize the ship even more thoroughly."

We have been contacted by guests on this ill fated cruise as well passengers from the prior cruise who became ill.

Passengers who contacted Royal Caribbean say that the cruise line is not considering refunds of any type.

There has been no official word from the CDC whether this is in fact norovirus, although the symptoms are consistent with the virus. The cruise lines invariably blame the passengers, but the CDC has never in my experience ever pin-pointed the exact source of an outbreak like this.

NBC News raises the issue whether the outbreak on the Explorer is linked to a nasty new type of norovirus known as the GII 4 Sydney strain which caused an outbreak on the Queen Mary 2.

There is no indication whether the illness is due to norovirus, e-coli or some other virus or bacteria.

The CDC is working with Health Canada officials as the cruise ship sails in Canada on its way to Bayonne, New Jersey, The cruise ship will arrival in Bayonne on October 5, 2013.

The CDC will send an epidemiologist and an environmental health officer to meet the ship and conduct an epidemiologic investigation and environmental health assessment, and monitor the sanitation procedures onboard prior to the embarkation of new passengers.

Over 14% of the passengers being sick with gastrointestinal illness is a very high percentage.

In the past week, we have reported about cruise ship norovirus outbreaks on two Fred Olsen cruise ships, the Black Watch and the Boudicca.

Professor Ross Klein's website reports that the Caribbean Fantasy, operated by American Cruise Ferries, failed a surprise inspection by the Centers for Disease Control and Prevention last month.

The Caribbean Fantasy received a failing score of 81. The CDC report is, in a word, gross.

The CDC discovered major problems with the maintenance of the ship's potable water tanks and bunkering system.

The most disgusting findings were the discovery of "numerous food safety violations" where the ship's staff used storage lockers to improper store food and galley equipment and utensils. CDC inspectors found "pests" in the storage lockers which started to be cleaned only during the CDC inspection.

The CDC found a refrigerator out of order, an oven in the galley out of order, a door to another oven broken, and a dishwasher broken.

Among other disgusting findings by the CDC:

"Multiple condiments and salt and pepper shakers stored among soiled pots and pans."

"Numerous large plastic containers, pots, pans, baking sheets, and coffee carafes were stored as clean but still soiled with food remnants."

"Different sizes of live nymph cockroaches were under the shelves where galley equipment was stored."

Earlier this week, we mentioned that the Centers for Disease Control Prevention (CDC), as past of its Vessel Sanitation Program, gave failing scores to two cruise ships following inspections this summer. The cruise ships involved were Regent's Seven Seas Navigator and Un-Cruise Adventures' Safari Endeavour. Both ship flunked the CDC's sanitation inspections.

The Seven Seas Navigator scored a 79 and the Safari Endeavour scored a 81.

It's damning to Silver Shadow's sanitation practices. Quite frankly, it's worse than I expected. The final score is 82 (it was initially 84). Here's a portion of the report:

Site: Other-Galley Crew Cabins

Violation: An organized effort was made to physically remove over 15 full trolleys of dry foods, spices, canned foods, cooked foods, milk, raw meats, pasteurized eggs, cheeses of all types, baking goods, raw fruits, raw vegetables, and a variety of both hand held and counter model food equipment, pans, dishware and utensils to over 10 individual cabins shared by two or three galley crew members in order to avoid inspection by VSP staff. All the out of temperature potentially hazardous foods were discarded along with most other foods that were not canned or in original containers. The lead VSP inspector poured concentrated chlorine liquid over all the discarded foods as they were dumped into garbage bags to ensure they would not be used again

The report contains no photos, but you can see some of the photos we posted last week on our Facebook page.

We also asked crew members from other cruise lines whether cruise ships playing "hide and seek" from the USPH is a common practice in the cruise industry. Its not a scientific poll, but around 90% of crew members said "yes." Take a look here.

Former Silversea Cruises employees contacted me earlier this year and complained that they were ordered to take trolleys of pots and pans, cutlery and food items from the galley and hide them away from the U.S. public health inspectors in the crew cabins and hallways. We told them to report this practice to the CDC which later boarded, inspected and flunked the Silver Shadow.

The reaction to the story has been mixed. Passengers who learned of the failed score and the alleged "hide and seek" tactics of the cruise ship appear to be upset not only with the unsanitary practice but with what they characterize as dishonesty and a lack of transparency by the cruise line. You can see this sentiment in a series of comments on the popular Cruise Critic boards.

Silversea will not respond to inquiries from our firm, but suggests in a PR statement it released that the incident is an aberration, pointing out that the scores on its previous inspections throughout its small fleet of cruise ships have been in the high 90"s and it also recently scored a perfect 100.

This argument, in my opinion at least, seems to be no different than a student caught cheating on a test who defends his failed score by pointing out that he received straight A's on all of the previous tests. The student's dishonesty is surpassed only by his disingenuity.

The other reaction to the story is that this is "business as usual." This sentiment is being expressed by crew members. We have heard from crew members over the last 20 years who have told us of similar stories of the lengths to which some cruise lines go to obtain a passing USPH score. The comments to our article on Facebook, by crew members at least, are to the effect that this practice is wide spread on other cruise ships. It was back luck that Silversea got caught.

My Cruise Law News Facebook page has over 60,000 followers, and the majority are crew members from all over the world. The consensus seems to be that all cruise lines engage in this practice to one extent or the other. I'd like to flush this issue out further. So I will post a simple question on my Facebook page:

Cruise Critic is reporting that three cruise ships recently failed inspection by the Centers for Disease Control and Prevention (CDC).

The cruise ships are the Celebrity Summit, Princess Cruises' Golden Princess and the SeaDream II.

Take a moment and read the actual CDC reports of these ships. They are disgusting.

You can understand how easily norovirus and other gastrointestinal viruses can spread after reading about cooks and food handlers working while they are suffering from acute gastrointestinal symptoms. The monitoring of water treatment on some of these cruise ships is spotty and there was even one ship using a reverse osmosis system (which is suppose to be used only when the ship is underway) that was sucking up nasty water in the ports.

The report for the Celebrity Summit is here. You will read about several crew members, including food handlers, who were suffering from acute gastrointestinal (referred to as AGE) symptoms but were still working, including handling food. The gastrointestinal surveillance logs were not being completed. There were widespread dirty and greasy conditions with flies and insect droppings in the bars and galleys.

The report for the Golden Princess is here. The Princess Cruises ship also had crew members with acute gastrointestinal symptoms continuing to work throughout the day even though they were obviously ill in the morning. An assistant buffet steward was suffering from GI problems but worked the buffet from 9:30 Am and did not report to the ship infirmary until 4:00 PM. There were inadequate reports regarding potable water facilities. The ship had dirty and soiled areas, including the signature Princess restaurant Sabatini's.

The report for the Sea Dream Yacht Club's Sea Dream II is here. This is the ship that was operating its water system continuously, including at port, and had been doing so for years. There were also dirty and unsanitary conditions noted.

The next time there is a norovirus outbreak and the cruise line instantaneously blames the passengers for not washing their hands, there may be a lot more to the story.

March 27, 2013 Update: In reading cruise expert Professor Ross Klein's website, I realized that Cruise Critic omitted another failed CDC score by the Caribbean Fantasy operated by America Cruise Ferries. You can read the report here. The deficiencies include failing to maintain acute gastrointestinal sickness logs, potable water deficiencies, galley and potwash cleaning shortcomings, and the failure to maintain cleaning equipment in proper order including several dish-washing machines and conveyors which had been not in proper condition for over a year.

The Fiji Broadcasting Corporation (FBC) reports that a Royal Caribbean cruise ship berthed at the Suva Wharf in Fiji was quarantined today by authorities following what is described as an outbreak of norovirus. The Health Ministry in Fiji reportedly confirmed 51 cases of the contagious virus on board the Rhapsody of the Seas which is carrying around 2300 passengers and 870 crew.

The FBC states that affected passengers have been isolated and no one is allowed to enter the quarantined area on the ship except the medical response team.

The cruise ship will leave Fiji for Noumea, New Caledonia later tonight.

Because this outbreak occurred on a cruise ship which did not call on a U.S. port, it will not be reported to the Centers for Disease Control (CDC).

You can get norovirus from an infected person, contaminated food or water, or by touching contaminated surfaces.

Flies. Dirty and malfunctioning ice machines, refrigerators & dishwashers. More flies. Dust, dirt, food residue, and debris. Flies and more flies. Flies where food is prepared. Flies where food is stored. Ugh. These unsanitary problems are part of a ridiculously long list that the U.S. Centers for Disease documented during a surprise inspection last month aboard the Holland America Line's Veendam cruise ship.

The inside word is that most "surprise" inspections are not surprises at all. Most of the time the cruise lines are tipped off and immense pressure is suddenly applied on the crew to bring the ship up to standards. But here, at least, there was no advance warning. And this is what you get.

A number of cruisers have been contacting our office asking about a sickness outbreak aboard the Celebrity Cruises' Constellation cruise ship.

The Centers for Disease Control ("CDC") officially placed the Constellation on its vessel sanitation list of ships with sickness. The Constellation sailed on January 28th from Fort Lauderdale and returned yesterday, February 11th.

95 out of 1,992 passengers reported being ill during the voyage (4.77%). 12 crewmembers reported being ill. The sick passengers and crew reported symptoms of vomiting and diarrhea.

Only cruise lines calling on U.S. ports are required to report disease outbreaks to the CDC. Cruise lines are required to make the report only when 3% or more of passengers or crew reported symptoms of diarrheal disease to the ships medical staff during the voyage. Under-reporting occurs regularly because many passengers can't make it away from their toilets due to diarrhea, and some passengers don't want to be confined to their cabins.

This is the fifth "official" cruise ship sickness outbreak which has found its way onto the CDC database which lists the Celebrity Silhouette, Celebrity Constellation, Royal Caribbean Voyager of the Seas, Princess Cruises' Crown Princess and P & O Cruises Aurora cruse ships. The CDC data does not include the outbreak on Princess Cruises' Ruby Princess, which we reported on last week.

The CDC has confirmed norovirus only on the Crown Princess and Aurora. It is disappointing that the CDC can't figure out the type of disease on the other ships. In no cases did the CDC pin-point the cause of the outbreak, to either a virus brought on the cruise ships by a passenger, or unsanitary handling of food by a crew, or infected food and/or water. If the CDC can't figure out how the outbreak occurred, it seems hard to respond to the problem and eradicate the causative factors.

There has been a lot of criticism on how Celebrity Cruises handled the latest outbreak on the Silhouette. You can read the comments by passengers here.

How did Celebrity Cruises handle the outbreak on the Constellation? If you were on the cruise, please leave her comments below, pro or con.

November 5, 2012 Update:

News sources are reporting that the Constellation suffered another outbreak of norovirus, this time during a 12 day cruise which just returned to Southampton. BBC reports that 350 passengers became ill with vomiting and nausea. Read our article: Cruise Puke Fest: Norovirus Strikes Celebrity Constellation. if you were ill on that cruise please leave a comment at the end of that article.

In a story widely reported in the national media, the Centers for Disease Control failed Royal Caribbean's Monarch of the Seas after conducting a surprise vessel sanitation inspection last month.

On November 18, 2011, CDC inspectors boarded the Monarch of the Seas, which is the cruise line's oldest vessel, and found numerous public health risks and violations if the CDC's sanitary standards.

The popular online cruise community, Cruise Critic, first reported on the nasty situation, followed by the USA Today cruise blog, CruiseLog.

The CDC found a whopping 43 unsanitary conditions and "deficiencies" in the cruise ship's procedures which were in violation of the CDC's Vessel Safety Program (VSP) manual. Included in the report were the following:

It is rare for a cruise ship based in the U.S. to fail a CDC inspection.

For a cruise line which spent billions on its gigantic new Genesis class cruise ships the Oasis and the Allure of the Seas, it looks like its oldest cruise the Monarch is showing significant signs of neglect which risk sickening its passengers.

CruiseLog cites statistics from the U.S. Centers for Disease Control ("CDC") of 11 outbreaks of illnesses so far in 2011, down from 14 in 2010 and 15 in 2009. It concludes that this reflects a "downward trend that began several years ago as the industry increased prevention efforts."

But looking at the data at the CDC website, you can see that the "trend" is actually flat, with 14 to 15 outbreaks reported to the CDC for each the past 3 years (2008, 2009 and 2010). This year will probably end up with the same number of reported incidents.

There has been an additional outbreak reported to the CDC just since the CruiseLog article was published yesterday. HAL's Ryndam cruise ship has reported that more than 5% of its passengers reported to the ship's infirmary complaining of vomiting and diarrhea. You can read about this latest outbreak here. The cruise ship is returning to Tampa tomorrow.

Unfortunately, there seems to be an outbreak or two over the Christmas and New Year sailing somewhere each year, so we should reasonably expect there to be the usual number (14 to 15) this year as in past years.

My real criticism of the CruiseLog article is not whether the number is actually 15 versus 11. It is that the article really doesn't explain that the cruise ship outbreaks reported to the CDC are probably less than 50% of the actual number of incidents which occur around the world each year. Remember that cruise lines do not report sickness outbreaks to the CDC if the cruise does not call on a U.S. port. This is significant because many cruise lines re-positioned a greater number of their cruise ships to Europe and Asia in recent years compared to five years ago

Although it is difficult to track the incidents outside of the U.S., we have reported on a number of incidents this year.

For example, in September, norovirus broke out on Celebrity's Eclipse sailing out of Southampton, England. Royal Caribbean's cruise ships sailing out of this U.K. port remained on heightened alert for months. You will find no mention of this is in the official CDC database. The cruise lines certainly will never voluntarily disclose this.

In November, we reported on one death and 80 sick passengers on HAL's Veendam which experienced a sickness outbreak as the cruise reached in Rio de Janeiro.

The other issue that the CruiseLog does not explain is the cruise lines report disease outbreaks only when 3% of passengers are afflicted based on the number of ill passengers who appear in the ship infirmary. This is significantly less than the true number of those afflicted with viral illnesses. Many sick passengers know that they will be quarantined in their cabins or they simply do not want to wait in the long lines outside of the ship infirmary.

The Clinical Infectious Disease Journal reported earlier this year that 40% of passengers with a viral infection did not report being sick to the ship medical staff. If these passengers were included in the sickness count, then the number of CDC reportable cases would surely increase.

CruiseLog also points to Carnival as not reporting a single outbreak this year. Does that mean that Carnival has a vaccine against the cruise ship bug? Hardly. Consider the following comments by cruise passengers on the CruiseJunkie website about the Carnival Conquest last week:

"From a passenger: There was an outbreak of something vomiting and diarrhea starting on Tuesday of the cruise (4-11 Dec). My husband got sick on Thursday morning and was asked to stay in cabin on isolation. On Friday I came down with vomiting and diarrhea. We were told there were lots of people sick.

Another passenger writes: On our final day at sea suddenly all the crew was wearing gloves and none of the passengers were allowed to get their own plate or food at the buffet. Everything had to be served by the staff and they were constantly wiping down everything and making announcements about hygiene. We asked if something was going on and we were told no however by that night 3 of the seven people in our party were very sick and once we walked in on an employee in the bathroom vomiting very badly. A casino employee told us that night many of the crew and passengers were very sick.

When we were getting off the boat Sunday we saw stacks and stacks of mattresses in plastic they were loading on the ship. We still have people from our group sick and I wish we had been told something. We received no information and since I was traveling with two children and my seventy year old father I continue to be concerned."

Families intending to cruise and worried about norovirus should read news sources like CruiseLog with a grain of salt. There is no empirical evidence that norovirus and other cruise ship sicknesses are on the decline.

Regarding cruises not calling on a U.S. port, the best sources of information are anecdotal, like cruise community forums and websites not beholden to the cruise lines like Professor Ross Klein's CruiseJunkie.

Of some 1842 passengers on the cruise ship, 1532 (83%) returned questionnaires provided by the researchers. 236 (15%) met the norovirus definition.

This particular cruise had a passenger vomit in a public area during boarding, as well as 7 other incidents where passengers vomited in public. The Centers for Disease Control ("CDC") investigators concluded that some sick passengers may have been infected by the vomit (through aerosolized vomit or by touching contaminated surfaces) or they were infected by person-to-person contact, particularly by an ill cabin mate.

The CDC investigators also concluded that some of the public toilets on the cruise ship were out of hand soap and paper towels and dish washing machines did not do an adequate job sanitizing eating utensils. These shortcomings might have contributed to the outbreak.

Nothing new with these conclusions.

The two interesting points in my opinion revealed in the study:

Of the 236 ill passengers, 95 (40%) did not report to the infirmary. We have been told by many passengers on cruises plagued by norovirus that the actual number of sick passengers reported by the cruise lines to the CDC was far less than the actual number of passengers with norovirus. Cruise lines report only the number of passengers who report to the ship infirmary. This is a problem we have discussed before - Is Celebrity Cruises Under-Reporting Sicknesses to the CDC?

Perhaps the most interesting statistic is that 62% of ill passengers did not decrease their participation in public activities. Over 200 passengers ill with norovirus walking around the ship? Yuck. This undoubtedly led to the spread of the outbreak.

But most outbreaks of norovirus on cruise ships are no so clear cut. There appears to be no effort to scientifically determine the source of norovirus outbreaks.

As we have reported in prior blogs, the U.S. Food and Drug Administration (FDA) concludes that whereas "person to person" transmission of norovirus has been documented, "norwalk gastroenteritis is transmitted by the fecal-oral route via contaminated water and foods." The FDA reports that "water is the most common source of outbreaks and may include . . . water stored aboard cruise ships."

March 24, 2011 Update: USA Today's CruiseLog has a story today about this study, indicating that the study involved Celebrity Cruises' Mercury cruise ship in January 2009. As we pointed out in an earlier blog, the CDC investigated outbreaks on the Celebrity Mercury inJanuary and February 2009.

The interesting thing about the Mercury was that it experienced four cruises a year later, in 2010, with repeated outbreaks of norovirus until the CDC took the unprecedented step of issuing a no sail order, an event we covered last March: Centers for Disease Control: "Shut Mercury Cruise Ship Down!" It would have been interesting for the CDC to have studied the cause of the norovirus on this cruise ship for months in early 2010. Why did this particular cruise ship experience so many problems with norovirus? Certainly it was not just because a passenger puked on embarkation in January 2009?

The article suggests that the information came from the cruise line, although I do not see a quote or a press release from Royal Caribbean / Celebrity. The article is rather vague, as I'm sure it's more accurate to say that some passengers have norovirus-like symptoms. Stool samples have to be taken and analyzed ashore before anyone can conclude that norovirus exists. (There is still no official determination regarding the cause of the last round of sickness on the Mercury).

If this information is accurate, five cases of gastrointestinal sickness is not particularly significant. The Centers for Disease Control (CDC) "Vessel Sanitation Program" does not require the data to be reported until at least 2% of the passengers are affected (around 37 passengers).

It is possible that all five passengers were infected before they boarded the cruise ship, because there are reports of norovirus ashore of course. It is also possible that they contracted a virus after they boarded.

We have received a number of calls and emails asking for information about the Mercury's March 21st sailing. Here are some suggestions:

The Cruise Critic message board has a posting "People are Sick Again on the Mercury," where there is mention of a small number of passengers who may be ill. The cruise community message boards are sometimes a good source of information, particularly when the cruise lines are not forthcoming with information.

I have found that the CDC eventually responds to e-mails and telephone calls. The email for the CDC is cdcinfo@cdc.gov - be sure to include "Celebrity Mercury Cruise Ship - March 21st sailing" in the title of your email. The telephone number is 800-232-4636.

The PR person at Royal Caribbean who handles crisis management statements, including norovirus outbreaks, is Cynthia Martinez. Her email is CynthiaMartinez@rccl.com I would be interested if anyone receives a response.

We often hear from passengers directly from the cruise ships. If we hear something, we will update this article.

So far, no one is reporting an outbreak of sickness aboard Celebrity Cruises' Mercury cruise ship for its latest - March 21st - sailing. This is good news after the last three disastrous cruises.

Today's South Carolina Post and Courier newspaper runs the headline "Mercury Appears Free of Norovirus" in which the newspaper reports: "after several days at sea, the Celebrity Mercury seems finally free of a stomach bug that afflicted nearly 1,000 passengers on its previous three voyages from Charleston."

The Centers for Disease Control (CDC) reports numerous outbreaks of norovirus on cruise ships operated by Celebrity Cruises, Cunard, Holland American Lines, and Royal Caribbean.

Every time there is an outbreak, the cruise lines blame the passengers who board the cruise ships. The media picks up in this theme and often reports that the problem is not with the cruise ships but the passengers who board the ships already infected with norovirus. For example, in a recent article in the New York Times Travel Section "Stomach Bug Hits Cruise Ships," respected journalist Michelle Higgins writes " . . . the contaminated ships have since been disinfected . . . but such measures can’t prevent a sick passenger from coming aboard and infecting others." Ms. Higgins suggests that " the best defense is simple: wash your hands."

Unfortunately, the issue is not so simple.

According to the U.S. Food and Drug Administration (FDA), whereas "person to person" transmission of norovirus has been documented, "norwalk gastroenteritis is transmitted by the fecal-oral route via contaminated water and foods."

Contaminated Water Supplies On Cruise Ships?

The FDA indicates that contaminated water is one of the most likely causes of norovirus. The FDA reports that "water is the most common source of outbreaks and may include water from municipal supplies, well, recreational lakes, swimming pools, and water stored aboard cruise ships.

So whereas you always hear reports of extra cleaning of the bathrooms and cabins on infected cruise ships, there is never a mention of whether the potable water is tested and the results of the testing.

Contaminated Food Supplies On Cruise Ships?

In addition to water supplies on cruise ships being a potential source of the virus, food supplies on cruise ships can also sicken the passengers.

The FDA reports that "shellfish and salad ingredients are the foods most often implicated in norwalk outbreaks. Ingestion of raw or insufficiently steamed clams and oysters poses a high risk for infection with Norwalk virus. Foods other than shellfish are contaminated by ill food handlers."

It would be interesting to determine the job positions of the crew members infected with norovirus. For example, the CDC reports that sixty-nine crew members were reported ill on Celebrity's Mercury and Millennium cruise ships during recent cruises. How many of these crewmembers were cooks, waiters or food handlers?

The issue of eating oysters and other shellfish on cruise ships presents a double whammy. Cruise ships dump sewage 12 miles from shore, and the fecal material can contaminate shellfish which filter-feed. Both cruise passengers and people ashore can then be infected by eating contaminated shellfish.

Uncertainty Regarding Cause of Virus and Transmitting Agent

Although the CDC tries to determine the "causative agent" of the outbreak, this means that they are trying to determine the nature of the pathogen (i.e., whether it is norovirus or some other virus). But the CDC does not report whether the virus came from a person boarding the cruise ship or, the more likely scenario if the FDA is correct, from contaminated food and water on the cruise ship.

The issue arises where do the cruise lines obtain their potable water? From U.S. based vendors or from the Caribbean islands? What testing is done at the ports before the water is brought aboard? Where do the food products come from? Is any of the food inspected by the FDA before it is loaded on the cruise ships?

The CDC reports that around 600 passengers became ill on Celebrity's Mercury cruise ship on the last two cruises alone. Are we to believe that all 600 people simply failed to wash their hands? Or is there something in the food and water?

Cruise lines should be required to publicly report the test results of the cruise ship's water samples, so that the U.S. public can determine the true cause of cruise ship illnesses.

If contaminated water is the culprit, all of the external cleaning of cruise ship surfaces is not going to solve the problem.

Around 450 passengers and crew are sick with nausea, vomiting and diarrhea aboard Celebrity's Mercury as the ill cruise ship completes its inaugural cruise to the Caribbean from the port of Charleston, South Carolina. The cause of the illness is unknown. The cruise ship will sail again from Charleston tomorrow, and many new passengers don't want to set foot on the ship.

This is not what the city of Charleston or the thousands of passengers who paid for a relaxing cruise to the Caribbean bargained for.

In ABC News' story "400-Plus Passengers Get Sick on Cruise," the cruise line's PR spokesperson, Cynthia Martinez, says that the ship doctors are giving passengers anti-nausea and diarrhea medication such as Pepto-Bismol . . . "

Pepto-Bismol?

The cruise line is in overdrive trying to clean the cruise ship. The web site of a local news station in Charleston carries the story "Mercury Crews Scramble to Clean Cruise Ship." The ship's crewmembers are "conducting some 'enhanced cleaning,' according to Ms. Martinez.

"Enhanced cleaning?" What the heck does that mean? And what exactly are they cleaning?

The cruise line has not even established the type of pathogen or virus involved and its source. Large scale sickness like this on a cruise ship can come from numerous sources - such as a contaminated water supply, improperly prepared food, or norovirus in bathrooms. The Norovirus Blog reports that cruise ship norovirus outbreaks are linked to the ship's bathrooms, and we addressed this issue last year in our blog "Cruise Ship Norovirus - Clean the Damn Toilets!"

But so far, there is no indication that norovirus in the ship's bathrooms is the culprit. If the ship's water supply is contaminated, all of the external cleaning in the world is not going to eradicate the problem.

And at this point, it does not look like the cruise line knows, or at least it is not disclosing the source of the problem to the public or the next 1,800 passengers who are boarding the cruise ship tomorrow. Instead, the cruise line is implying that its the passengers who are the problem because they are not washing their hands, rather than the ship which is infecting the passengers.

This week our office has received a number of inquiries from passengers who are frightened to sail on the Mercury tomorrow. They wonder whether they can cancel their cruise and get their money back. Unfortunately, the cruise line's lawyers have spent years crafting terms and conditions in the passenger tickets which protect the cruise line, not the consumer. And if the passenger has travel insurance, the insurance company probably won't pay if the passengers cancel because they are not sick (yet) and the cruise ship will sail again tomorrow, come-hell-or-high-water.

The cruise line is promising to give sick passengers a voucher "based on the number of days a guest is isolated divided by the total of cruise fare paid." Huh? These nice people are sitting on a crapper in their cabins, vomiting into a waste can on their lap. All they get is a voucher for partial payment for another cruise? That's a crappy deal, excuse the pun.

What a predicament for these folks. Tomorrow, the cruise line will unload the 1,800 passengers from the Mercury and load another 1,8000 back on. And the Mercury will set sail again, this time for a 10 day cruise to Mexico, Belize, the Bahamas, and Key West.

We wish the passengers luck.

And don't forget to take a large bottle of Pepto-Bismol with you . . .

The Associated Press reports that hundreds of passengers have fallen ill with a stomach ailment aboard the cruise ship Mercury, operated by Celebrity Cruises, which is sailing in the Caribbean.

Over 300 of the 1,800 passengers are experiencing upset stomachs, vomiting and diarrhea. Another 25 or so crewmembers are also ill. The Mercury left Charleston, South Carolina on February 15th and this is the first cruise from Charleston.

The PR person for Celebrity / Royal Caribbean stated that the cruise ship's medical facilities were "overwhelmed" and another doctor and nurse boarded the Mercury in St. Kitts.

The cruise line did not report what virus or pathogen was involved, but the cruise ship dropped samples off in Puerto Rico for testing. The ship is scheduled to return to Charleston on Friday.

The Centers for Disease Control (CDC) recorded two outbreaks of gastrointestinal illness on the Celebrity Mercury last year. The CDC investigated outbreaks on the Celebrity Mercury inJanuary and February 2009.

Celebrity's Mercury was in the news just last week when a Hazmat team and ambulances arrived at the port in Baltimore after 6 crewmembers became ill after inhaling fumes while welding on the cruise ship. The crewmembers may have poisoned due to carbon monoxide as reported in the press, although there was no carbon monoxide detected when the cruise ship arrived in port the following day. The cruise ship then repositioned to Charleston for this cruise.

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